Docs Get Animated About Underused Trauma Tx (with video)

The video was prompted by a report earlier this year indicating that British hospitals were using tranexamic acid in only 3% of trauma patients eligible to receive it.

Ian Roberts, MD, head of the CRASH-2 team, told MedPage Today in an email that military leaders were quick to put the results into practice, with the British armed forces adopting them immediately and the Pentagon following suit a short time later.

"However, changing civilian medical care is another story even though the use of this cheap drug could save 140,000 lives per year," Roberts said. MedPage Today

Rewiring the Brain to Ease Pain

How you think about pain can have a major impact on how it feels. That's the intriguing conclusion neuroscientists are reaching as scanning technologies let them see how the brain processes pain. 

That's also the principle behind many mind-body approaches to chronic pain that are proving surprisingly effective in clinical trials. Some are as old as meditation, hypnosis and tai chi, while others are far more high tech. In studies at Stanford University's Neuroscience and Pain Lab, subjects can watch their own brains react to pain in real-time and learn to control their response—much like building up a muscle. When subjects focused on something distracting instead of the pain, they had more activity in the higher-thinking parts of their brains. When they "re-evaluated" their pain emotionally—"Yes, my back hurts, but I won't let that stop me"—they had more activity in the deep brain structures that process emotion. Either way, they were able to ease their own pain significantly, according to a study in the journal Anesthesiology last month. Wall Street Journal  PDF

Malpractice suits cause psychological distress and career burnout among US surgeons

According to the results of a new study published in the November 2011 Journal of the American College of Surgeons, malpractice lawsuits against U.S. surgeons occur often and can take a profound personal toll on the surgeon, resulting in emotional exhaustion, stress, and professional dissatisfaction.

The researchers examined personal and professional characteristics and found malpractice lawsuits were strongly and independently linked to surgeon depression and career burnout. The stress caused by malpractice litigation was rated as equivalent to that of financial worries, pressure to succeed in research, work/home conflicts, and coping with patients' suffering and death. Finally, surgeons who experienced a recent malpractice lawsuit reported less career satisfaction and were less likely to recommend a surgical or medical career to their children or others. Eurekalert! PDF

Predictors of healing and functional outcome following transmetatarsal amputations.

Transmetatarsal amputations have low healing rates, and patient demographic characteristics and preoperative assessment do not help predict healing. Transmetatarsal amputation healing, however, significantly predicts subsequent ambulatory status and should be pursued in patients with good rehabilitation potential. Landry GJ, Silverman DA, Liem TK, Mitchell EL, Moneta GL. Arch Surg. 2011 Sep;146 9):1005-9. PMID: 21930995  PDF

Ultrasound-Guided Interventional Release of Rotator Interval and Posteroinferior Capsule for Adhesive Capsulitis of the Shoulder Using a Specially Designed Needle.

Adhesive capsulitis is a common but poorly understood disorder of the shoulder. Various treatments have been developed to manage this condition, but the efficacy of these treatments is controversial. We developed an ultrasound-guided, minimally invasive interventional technique to manage adhesive capsulitis of the shoulder using a specially designed needle. Ahn K, Jhun HJ, Choi KM, Lee YS. Pain Physician. 2011 Nov;14(6):531-537. PMID: 22086094 PDF

Journal of Hand Surgery (European) [Epub ahead of print]

1. The effect of the involvement of the dominant or non-dominant hand on grip/pinch strengths and the Levine score in patients with carpal tunnel syndrome. Zyluk A, Walaszek I. J Hand Surg Eur Vol. 2011 Nov 15. [Epub ahead of print] PMID: 22086788 PDF

2. Early CT for suspected occult scaphoid fractures. Stevenson JD, Morley D, Srivastava S, Willard C, Bhoora IG. J Hand Surg Eur Vol. 2011 Nov 15. [Epub ahead of print] PMID: 22086787 PDF

3. Efficacy of locking plate fixation in stabilizing distal radius fractures in patients aged 50 years or over.

Tawfik J, Powell-Smith E, Bremner-Smith A. J Hand Surg Eur Vol. 2011 Nov 15. [Epub ahead of print] No abstract available. PMID: 22086786 PDF

4. In de Quervain’s with a separate EPB compartment, ultrasound-guided steroid injection is more effective than a clinical injection technique: a prospective open-label study. K. Kume, K. Amano, S. Yamada, K. Amano, N. Kuwaba,  H. Ohta. J Hand Surg Eur;  first published on November 17, 2011. PDF

5. Entrapment of the extensor pollicis longus tendon after a radial fracture in a child. Jose Maria Cavanilles Walker, Angel Masferrer Pino, Gloria J Hand Surg Eur; first published on November 16, 2011.  PDF 

6. How to prevent the avulsed soft tissues from wrapping around the K-wire.  James Henderson,  Peter Chapman, Bulent Ozcelik, Onur Egemen Re: Ozcelik B, Egemen O, Sacak B.  2011, 36: 518–9 J Hand Surg Eur,  first published on November 16, 2011. PDF

Determination of pelvic orientation from sparse ultrasound data for THA operated in the lateral position.

B-mode ultrasound imaging has the potential to replace conventional percutaneous digitization of bony landmarks in navigated total hip arthroplasties (THAs). For THAs operated in the lateral position, only one side of the pelvis is freely accessible. This paper presents a new ultrasound to statistical shape model (SSM) registration method for operating the pelvis in the lateral position, based on sparse ultrasound images, which does not interfere with the clinical routine in terms of redraping and repositioning the patient. Schumann S, Nolte LP, Zheng G. Int J Med Robot. 2011 Nov 14. doi: 10.1002/rcs.443. [Epub ahead of print] PMID: 22081512

AAOS News: New pediatric supracondylar humerus fractures CPG

At their meeting on Sept. 24, 2011, the AAOS Board of Directors approved a new clinical practice guideline (CPG) on the treatment of pediatric supracondylar humerus fractures. This is the third CPG to focus on a primarily pediatric condition.

Supracondylar fractures of the humerus are widely considered to be the most common fracture of the elbow in children (Fig. 1). Approximately 3 percent of all fractures in children are supracondylar fractures. They often result from trauma to the elbow, most often due to a fall from a height or related to sports or leisure activities. AAOS

Recent Skeletal Radiology Articles

Hemi-bucket-handle tears of the meniscus: appearance on MRI and potential surgical implications PDF

Traumatic detachment of the inferior angle of the scapula in a 5-year-old boy—a sonographic diagnosis PDF

Recent Military Ortho Articles in PubMed

1. Median nerve repair with autologous sciatic nerve graft: a case report. Ragel BT, Park GC, Brevard S.

ISRN Surg. 2011;2011:120367. Epub 2011 Apr 26. PMID: 22084742

2. Predisposing risk factors for non-contact ACL injuries in military subjects. Evans KN, Kilcoyne KG, Dickens JF, Rue JP, Giuliani J, Gwinn D, Wilckens JH. Knee Surg Sports Traumatol Arthrosc. 2011 Nov 12. [Epub ahead of print] PMID: 22080351

3. Anemia, Iron Deficiency, and Stress Fractures in Female Combatants During 16 Months. Yanovich R, Merkel D, Israeli E, Evans RK, Erlich T, Moran DS. J Strength Cond Res. 2011 Nov 10. [Epub ahead of print] PMID: 22080308

4. Management of head trauma due to landmine explosions: From battle field to operation room. Atabey C, Asir A, Ersoy T. Br J Neurosurg. 2011 Nov 11. [Epub ahead of print] PMID: 22077586

5. The epidemiology of cross country skiing injuries. Howes J, Droog SJ, Evans J, Wood IM, Wood AM. Br J Sports Med. 2011 Dec;45(15):A20. PMID: 22077033

6. Military sports medicine clinics should continue to organise MRI prior to listing for "fast track" meniscectomy. Howes J, Wood AM, Bell DJ, Wrigley S, Angus C. Br J Sports Med. 2011 Dec;45(15):A17. PMID: 22077019

7. Fast track surgery for anterior cruciate ligament reconstruction in military patients in Scotland.

Howes J, Wood AM, Bell DJ, Wrigley S, Angus C. Br J Sports Med. 2011 Dec;45(15):A15. PMID:  22077012

The epidemiology of fractures of the proximal ulna.

Fractures of the proximal ulna are fragility fractures that predominantly occur in elderly patients. Given the number of elderly patients sustaining these injuries, research is needed to determine the role of non-operative treatment for these fractures, particularly in patients with multiple co-morbidities and low functional demands.

Duckworth AD, Clement ND, Aitken SA, Court-Brown CM, McQueen MM. Injury. 2011 Nov 9. [Epub ahead of print] PMID: 22077988 PDF

The Athlete's Pain: Hip Impingement or Bone Shaving Surgery Grows Popular

It is one of the most popular operations in sports medicine. It comes in various forms, all with the same name: Hip impingement or bone shaving surgery. World-renowned athletes have had the operation — the Yankees’ third baseman Alex Rodriguez had it about two years ago and the sprinter Tyson Gay had it last summer.

But some sports medicine researchers are asking: where is the evidence that shaving bone helps? Might the bumps or irregular shapes they call impingement be just normal variations? Does the shaved bone grow back? NYT

Locked intramedullary femoral nailing without fracture table or image intensifier

The present retrospective study aims to evaluate the outcome in 41 patients of femoral shaft fractures, who had closed intramedullary nailing in lateral decubitus position without fracture table or image intensifier. Mean age was 33.2 (range, 18–70) years. The cannulated reamer in proximal fragment (as intramedullary joystick) and Schanz screw in the distal fragment (as percutaneous joystick) were simultaneously used to assist closed reduction of the fracture without the use of image intensifier. Closed reduction was successful in 38 patients. Open reduction was required in 3 patients. Schanz screw was used for closed reduction in 12 patients. Average number of intra-operative radiographic exposures was 4.4. Two patients had exchange nailing using large diameter nails. One patient had nonunion. Angular and rotatory malalignments were observed in seven patients. We are of the opinion that the present technique is a safe and reliable alternative to achieve closed locked intramedullary nailing and is best suited to stable, less comminuted (Winquist–Hansen types I and II) diaphyseal fractures of the femur. Rajesh Rohilla, Roop Singh, Seema Rohilla, Narender K. Magu, Ashish Devgan and Ramchander Siwach. Strategies in Trauma and Limb Reconstruction Nov 2011 [Epub ahead of print] PDF

Recent Navy Ortho Publications

1. Identification of the Radial Nerve During the Posterior Approach to the Humerus: A Cadaveric Study. Seigerman DA, Choung EW, Yoon RS, Lu M, Frank MA, Gaines RJ, Liporace FA. J Orthop Trauma. 2011 Sep 10. [Epub ahead of print] PMID:  21918485
2. Joint chondrolysis. Provencher MT, Navaie M, Solomon DJ, Smith JC, Romeo AA, Cole BJ.

J Bone Joint Surg Am. 2011 Nov 2;93(21):2033-44. PMID:  22048100

3. Low Complication Rate Associated With Raising Mature Flap for Tibial Nonunion Reconstruction. Will RE, Fleming ME, Lafferty PM, Fletcher JW, Cole PA. J Trauma. 2011 Oct 13. [Epub ahead of print] PMID: 22002619

4. Low lumbar burst fractures: a unique fracture mechanism sustained in our current overseas conflicts. Lehman RA Jr, Paik H, Eckel TT, Helgeson MD, Cooper PB, Bellabarba C. Spine J. 2011 Oct 7. [Epub ahead of print] PMID:  21982760

5. Two-Year Outcomes of Open Shoulder Anterior Capsular Reconstruction for Instability From Severe Capsular Deficiency. Dewing CB, Horan MP, Millett PJ. Arthroscopy. 2011 Oct 5. [Epub ahead of print] PMID:  21978433

6. Technique: bone-patellar tendon-bone autograft ACL reconstruction in the young, active patient. Provencher MT, Ryu JH, Gaston T, Dewing CB. J Knee Surg. 2011 Jun;24(2):83-92. Review. PMID:  21874943

7. Hand infections. McDonald LS, Bavaro MF, Hofmeister EP, Kroonen LT. J Hand Surg Am. 2011 Aug;36(8):1403-12. PMID: 21816297

8. Total knee arthroplasty in a patient with pseudopseudohypoparathyroidism. Fraser MR Jr, Sechriest VF 2nd. Orthopedics. 2011 Aug 8;34(8):e413-7.  PMID: 2815586
9. Combat-related pelvis fractures in nonsurvivors. Bailey JR, Stinner DJ, Blackbourne LH, Hsu JR, Mazurek MT. J Trauma. 2011 Jul;71(1 Suppl):S58-61. PMID: 21795891

10. Use of an "Antibiotic Plate" for Infected Periprosthetic Fracture in Total Hip Arthroplasty. Liporace FA, Yoon RS, Frank MA, Gaines RJ, Maurer JP, Polishchuk DL, Choung EW. J Orthop Trauma. 2011 Jul 28. [Epub ahead of print] PMID: 21804411
11. Heterotopic ossification in complex orthopaedic combat wounds: quantification and characterization of osteogenic precursor cell activity in traumatized muscle. Davis TA, O'Brien FP, Anam K, Grijalva S, Potter BK, Elster EA. J Bone Joint Surg Am. 2011 Jun 15;93(12):1122-31. PMID: 21776549

12. Blast-induced lower extremity fractures with arterial injury: prevalence and risk factors for amputation after initial limb-preserving treatment. Gwinn DE, Tintle SM, Kumar AR, Andersen RC, Keeling JJ.

J Orthop Trauma. 2011 Sep;25(9):543-8.PMID:  21654527
13. Glenohumeral arthritis in the young adult. Provencher MT, Barker JU, Strauss EJ, Frank RM, Romeo AA, Matsen Iii FA, Cole BJ. Instr Course Lect. 2011;60:137-53. PMID: 21553769
14. Evolution of rotator cuff repair techniques: are our patients really benefiting? Provencher MT, Kercher JS, Galatz LM, Elattrache NS, Frank RM, Cole BJ. Instr Course Lect. 2011;60:123-36. PMID: 21553768 15. Humanitarian assistance and disaster relief aboard the USNS Mercy (TAH-19). Provencher MT, Douglas TD. J Surg Orthop Adv. 2011 Spring;20(1):38-43. PMID:  21477532
16. Extrinsic compression of the external iliac artery following internal fixation of an acetabular fracture.

Koelling E, Mukherjee D. J Vasc Surg. 2011 Jul;54(1):219-21. Epub 2011 Feb 11. PMID: 21315543
17. Analysis and comparison of the biomechanical properties of univalved and bivalved cast models.

Crickard CV, Riccio AI, Carney JR, Anderson TD. J Pediatr Orthop. 2011 Jan-Feb;31(1):39-43. PMID: 21150730

Spinal Surgery Becomes More Cost-Effective Over Time

For specific causes of back pain, spinal surgery provides a good value over long-term follow-up, compared to nonsurgical treatment, concludes a report in the November 15th issue of Spine.

In patients meeting well-defined diagnostic criteria for spinal disorders, estimates of cost-effectiveness at four years' follow-up are more favorable than at two years. "Following effectiveness and cost patterns over time resulted in improved estimates of surgery's value," according to the new research led by Anna N.A. Tosteson, ScD, of The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, N.H. NewsWise

Meniscal Repair: World's first stem cell bandage in human clinical trials

Azellon's Cell Bandage has been designed as an alternative to the current treatment of surgical removal of the meniscus (meniscectomy), a procedure that more than 1.7 million people around the world per year are estimated to undergo. This common orthopaedic procedure often results in the early onset of osteoarthritis, leading to further joint surgery including total knee replacement.

The Cell Bandage, which in vitro (tissue culture) has shown great promise for the healing of meniscal tears, is grown from the patient's own stem cells and will be transplanted in the patient's knee joint within two weeks of extracting the stem cells from bone marrow. MedicalXpress

Skyscape’s version of Netter’s Atlas of Anatomy is an average Anatomy Atlas for iPad

Price:

• $79.99

Likes:

• Complete collection of anatomical illustrations covering the whole human body
• Numerous images cover anatomical areas from a number of views helping to understand the complex interplay between various anatomical structures.

Dislikes:

• Opening a new page when selecting a label
• Resolution of images when magnified can be poor making the anatomy unclear

Overall Rating:

• Whilst Netter’s Atlas of Human Anatomy is expensive, it is a complete anatomy text with decent anatomical illustrations.
• The labeling system needs updating before it can be fully recommended as the app is difficult to use when a new page opens once a label has been selected.
• Similarly there are potentially a number of issues relating to the low resolution of images during magnification.
• Overall Skyscape’s version of Netter’s Atlas of Anatomy is a good anatomy atlas, although it is not a stand out contender. iMedicalApps

Exclusive: Mobisante bringing their smartphone ultrasound probe to Android phones

With the release of their Ice Cream Sandwich OS, also called Android 4.0, Google will robustly support USB host mode — enabling phones to use USB devices similar to a traditional computer.

This type of robust connectivity prompted me to contact Mobisante, makers of the much heralded smartphone ultrasound device, MobiUS. One of their biggest limitations has been the inability to have proper USB 2.0 host support to connect to smartphones, forcing them to use an outdated Windows Mobile 6.5 OS on a Toshiba smartphone. iMedicalApps

New Paper in Drugs of the Future Describes Novel Anti-Infective Agent Against Both Gram Positive and Negative Pathogens

The current public health war against bacterial infections is rapidly approaching a critical stage, in which bacterial resistance to antibiotics becomes widespread and our reservoirs of available antibiotics and viable therapeutics are depleted. During the past 60 years, the rise in the frequency of resistance, particularly to multiple drugs, has thwarted the treatment of patients in the hospital and the community. According to Rabih Darouiche, MD of Baylor College of Medicine, microbial resistance is emerging faster than we are replacing our armamentarium of antimicrobial agents.

Dr. Darouiche, in collaboration with the product development team from NovaBay Pharmaceuticals, recently published a monograph on NovaBay’s lead Aganocide® NVC-422 in the journal Drugs of the Future. Newswise

Diagnostic accuracy of MRI in adults with suspect brachial plexus lesions: A multicentre retrospective study with surgical findings and clinical follow-up as reference standard.

The overall diagnostic accuracy of brachial plexus MRI calculated on a per-patient base is relatively high. The specificity of brachial plexus MRI in patients suspected of having a space-occupying mass is very high. The sensitivity is also high, but there are false-positive interpretations as well. Tagliafico A, Succio G, Serafini G, Martinoli C. Eur J Radiol. 2011 Nov 7. [Epub ahead of print] PMID: 22071340